Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-16T10:33:02.520Z Has data issue: false hasContentIssue false
  • English
  • Français

Social Medicine and “Leprosy” in the Peruvian Amazon*

Published online by Cambridge University Press:  11 December 2015

Marcos Cueto
Marcos Cueto*
Affiliation:
Universidad Peruana Cayetano Heredia, Lima, Peru
Get access Rights & Permissions [Opens in a new window]

Extract

Starting in the early twentieth century, Latin American physicians organized expeditions to study remote rural populations living in their own countries. These expeditions usually aimed to solve scientific mysteries, spread western medicine, protect urban populations from epidemic diseases coming from the countryside and increase the productivity of new areas of economic exploitation. They also produced fascinating knowledge, images and stereotypes on individuals and diseases considered rare in Latin American cities.

In this paper I will analyze a similar case: the medical dimension of an effort to “colonize” or modernize the Peruvian Amazon during the 1940s. This region, an expanse of more than 500 square kilometers, was—according to a prominent Peruvian economist—“territorio inculto” scarcely populated by primitive tribes. Economic, nationalistic and political motivations coincided in the term Colonización de la Amazonía used by governmental and international agencies. Its meaning included diverse proposals such as: to encourage the migration of Andean peasants, the implementation of scientific agriculture, the creation of rural schools and military posts, the “civilization” of local natives—a process developed by religious orders in the nineteenth century—and the construction of roads to facilitate access to urban markets.

Type
Research Article
Information
The Americas , Volume 61 , Issue 1 , July 2004 , pp. 55 - 80
Copyright
Copyright © Academy of American Franciscan History 2004 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

A preliminary version of this paper was presented at the Conference “Practices of Healing in Modern Latin America and Spain” organized by the Center of Latin American and Caribbean Studies and the King Juan Carlos I of Spain Center of New York University. The Conference took place in New York City on April 27-28, 2001.

References

1 See Lima, Nísia Trindade, Um sertäo chamado Brasil: intelectuais, sertanejos e imaginaçäo social (Rio de Janeiro; Fiocruz, 1997);Google Scholar Hochman, Gilberto, “Logo ali, no final da avenida: ‘Os Sertöes’ redefinidos pelo movimento sanitarista da Primeira República,” Historia, Ciencias, Saude-Manquinhos (supplement) 5 (1998), pp. 217–235;CrossRefGoogle Scholar Stepan, Nancy Leys, “Portraits of a Possible Nation: Photographing Medicine in Brazil,” Bulletin of the History of Medicine, 68 (1994), pp. 136–149.Google ScholarPubMed

2 Studies on the “colonization” of the Peruvian Amazon are: Jordán, Pilar García “Problemática de la Incorporación de las Selvas Amazónicas: Los Estados Nacionales Latinoamericanos, Siglos XIX-XX, algunas reflexiones sobre el caso peruano,” Boletín Americanista [Barcelona] 41 (1991), pp. 261–272;Google Scholar Martínez, Héctor, Las Colonizaciones Selváticas Dirigidas en el Perú: Antecedentes y Perspectivas (Lima: Universidad Nacional Mayor de San Marcos, 1976);Google Scholar Aramburú, Carlos, Bedoya, Eduardo and Recharte, Jorge Colonización en la Amazonía (Lima: Centro de Investigación y Población Amazónica, 1982);Google Scholar and Sjoholt, Peter, Tropical Colonization Problems and Achievements: The Case of Chanchamayo andSatipo in Peru (Stockholm: Institute of Latin American Studies, 1988).Google Scholar

3 Ferrero, Rómulo, Los Problemas de la Colonización en el Perú (Lima: Banco Agrícola del Peru, 1939), p. 2.Google Scholar Other contemporary examples of the colonization of the Amazon are: Delboy, Emilio, Memorandum sobre la Selva del Perú (Lima: Sanmartí y Cia, 1942);Google Scholar Pinedo, Víctor, Colonización y Geografía Médica Loretana (Iquitos: Imprenta el Oriente, 1940);Google Scholar Pérez, Coronel Enrique V., Marcha Hacia la Selva: Estudio Geográfico de la Selva Peruana (Lima: Imprenta Ministerio de Guerra, 1939).Google Scholar

4 See: Carmichael, Ann G., “Leprosy,” In: The Cambridge World History of Human Disease, Kipple, Kenneth F., ed. (Cambridge: Cambridge University Press, 1993), pp. 834–840;CrossRefGoogle Scholar Gussow, Z. and Tracy, G.S., “Stigma and the leprosy phenomenon: the social history of a disease in the 19th and 20th Centuries,” Bulletin of the History of Medicine 44 (1970), pp. 425–449;Google Scholar Silla, Eric, People are not the Same, Leprosy and Identity in Twentieth-Century Mali (Oxford: James Currey Ltd., 1998);Google Scholar Obregón, Diana, “Building National Medicine: Leprosy and Power in Colombia, 1870–1910,” Social History of Medicine, 15:1 (2002), pp. 89–108;CrossRefGoogle ScholarPubMed idem, Batallas contra la Lepra: Estado, Medicina y Ciencia en Colombia (Medellín: Fondo Editorial Universidad EAFIT, 2002); Worboys, Michael, “The colonial world as mission and mandate: leprosy and empire, 1900–1940,” Osiris 15 (2000), pp. 207–218;CrossRefGoogle ScholarPubMed Gussow, Zachary, Leprosy, Racism and Public Health, Social Policy and Chronic Disease Control (Boulder: Westview Press, 1989).Google Scholar

5 Information on leprosy in Peru of the 1940s citing a report by Pesce, Hugo appears in “Peru,” Boletín de la Oficina Sanitaria Panamericana 20:1 (1941), p. 7;Google Scholar Rebagliati, Raul, “La Situación Epidemiológica del Perú en 1939,” Boletín de la Dirección de Salubridad, Año 1940 (Lima: Imprenta Americana, 1940), pp. 240–265, 254.Google Scholar The Boletín was an irregular publicación that used the title usually given to ajournal but that it really was a series of independent publications. Most of these are kept at the Biblioteca Nacional and the Library of the Universidad Cayetano Heredia in Lima. In 1958 the total number of cases in Perú was 2,017; a rate of 0.19 per one thousand, see De Souza Lima, Lauro, “La Lepra en las Américas,” Boletín de la Oficina Sanitaria Panamericana 45 (Diciembre 1958), pp. 472–487, 474.Google Scholar

6 On the history of European social medicine, see Rosen, George, “What is Social Medicine? A Genetic Analysis of the Concept,” Bulletin of the History of Medicine 21 (1947), pp. 674–733;Google ScholarPubMed Porter, Dorothy and Porter, Roy, “What was Social Medicine? An Historiographical Essay,” Journal of Historical Sociology, 1:1 (1988), pp. 90–106,CrossRefGoogle ScholarPubMed Porter, Dorothy, ed., Social Medicine and Medical Sociology in the Twentieth Century (Amsterdam: Rodopi, 1997), pp. 90–106;CrossRefGoogle ScholarPubMed Weindling, Paul, “Social Medicine at the League of Nations Health Organization and the International Labour Office compared,” in Weindling, Paul, ed., International Health Organizations and Movements, 1918–1939 (Cambridge: Cambridge Univ. Press, 1995), pp. 134–153.CrossRefGoogle Scholar

7 On Social Medicine in Latin America, see Waitzkin, Howard, Iriart, Cecilia, Estrada, Alfredo, and Lamadrid, Silvia, “Social Medicine then and Now: Lessons from Latin America,” American Journal of Public Health 91:10 (October 2001), pp. 1592–1601.CrossRefGoogle ScholarPubMed

8 Barclay, Frederica, “Transformaciones en el espacio rural Loretano,” in La Construcción de la Amazonía andina, siglos XIX-XX: procesos de ocupación y transformación de la Amazonía peruana y ecuatoriana entre 1820 y 1960, Jordán, Pilar García, ed. (Quito: Abya-Yala, 1995), pp. 228–285;Google Scholar and Jordán, Pilar García, ed., Fronteras, Colonización y Mano de Obra Indígena, Amazonía andina (siglos XIX-XX), la construcción del espacio socioeconómico amazónico en Ecuador, Perú y Bolivia (1792–1948) (Lima: Pontificia Universidad Católica del Perú, 1998).Google Scholar

9 See Soldán, José Pareja Paz, Geografía del Perú (Lima: Lib. E Imp. Gil, 1937);Google Scholar Italiano, El Banco, El Perú en Marcha: Ensayo de Geografía Económica (Lima: Torres Aguirre, 1941), pp. 46–59.Google Scholar

10 The census of 1940 is summarized in República del Perú, de Hacienda, Ministerio y Comercio, , Censo Nacional de Población y Ocupación, Vol. 1 (Lima: Dirección Nacional de Estadística, 1944), p. cxlix.Google Scholar

11 Zolezzi, Enrique Rojas, Los Ashaninka: un pueblo tras el bosque (Lima: Pontificia Universidad Católica del Perú, 1994).Google Scholar

12 Barclay, Federica, La Colonia del Perené: Capital Inglés y Economía Cafetalera en la Configuración de la región de Chanchamayo (Iquitos: Centro de Estudios Teológicos de la Amazonia, 1989);Google Scholar Shomaker, Robin, The Peasants of El Dorado: Conflict and Contradiction in a Peruvian Frontier Settlement (Ithaca: Cornell University Press, 1981).Google Scholar

13 Report on Perené Colony Sanitary and Health Conditions, April 1939. Peruvian Corporation Limited Papers, Special Collections, Library Services, University College, London, UK (hereafter Peruvian Corporation Papers).

14 “La Corporación Peruana del Amazonas,” in Marie, Darío Sainte, Perú en Cifras, 1944–1945 (Lima: Empresa Gráfica Scheuch S.A., 1945), p. 112.Google Scholar

15 Moreyra, Carlos, Manuel Prado, Político y Gobernante (Lima, 1974), p. 50.Google Scholar

16 The Corporation comprised all or part of the Departments of Cajamarca, Amazonas, San Martín, Loreto, Huánuco, Pasco, Junín, Ayacucho, Apurímac, Cuzco, Madre de Dios, and Puno. “Corporación Peruana del Amazonas,” In Marie, Sainte, Perú en Cifras, p. 112.Google Scholar

17 “Ministerio de Agricultura,” Marie, Sainte, Perú en Cifras, p. 102.Google Scholar

18 Barclay, , “Transformaciones,” p. 266.Google Scholar

19 Mertens, Walter, “Políticas poblacionales en la Amazonía Peruana,” Amazonía Peruana (Lima) 13 (September 1986), pp. 35–66.Google Scholar

20 On this process see Barclay, “Transformaciones.”

21 Ibid., p. 236.

22 Paz Soldán, Carlos Enrique, Trabajos del Instituto de Medicina Social (Lima: Instituto de Medicina Social, 1936).Google Scholar A bibliography of his works appears in “Carlos Enrique Paz Soldán,” Anuario Bibliográfico Peruano (1970–1972) (Lima: Biblioteca Nacional, 1978), pp. 703–733.

23 Sand mentions Paz Soldán and Kuczynski in an international overview of social medicine, Sand, René, The Advance to Social Medicine (London: Stapless Press, 1952), p. 552.Google Scholar

24 See Stepan, Nancy Leys, The Hour of Eugenics: Race, Gender and Nation in Latin America (Ithaca: Cornell Univ. Press, 1991).Google Scholar

25 Some of Paz Soldán's first studies on social medicine are: La Medicina Social (ensayo de sistematización) (Lima: Imprenta Sagrados Corazones, 1916); idem, Las Bases medico sociales de la legislación sanitaria en el Perú (Lima: Lib e Imp. El Inca, 1918).

26 Paz Soldán, Carlos Enrique, La Escuela Medica Peruana: Por los Senderos de Unanue (Lima: Biblioteca del Centenario de Hipólito Unanue, 1932);Google Scholar idem, “El Dominio de la Selva por la Medicina Social,” Boletín de la Sociedad Geográfica de Lima 37–38 (1921), pp. 436–441.

27 Biographical information appears in “Kuczynski-Godard, Máxime,” Diccionario Enciclopédico del Perú (Lima: Milla Batres, 1986) Vol. V, p. 136; and Cueto, Marcos, “Un médico Alemán en los Andes: La visión médico social de Maxime Kuczynski-Godard,” Allpanchis (Lima) 56 (2001), pp. 39–74.Google Scholar

28 “Laboratorios del Instituto de Medicina Social, recientemente instalados bajo la Dirección Técnica del Prof. Maxime Kuczynski-Godard,” La Reforma Médica [Lima] (June 15, 1938), pp. 484–485. La Reforma Médica was an irregular journal and a press owned and directed by Paz Soldán. An almost complete collection is kept at the Biblioteca Nacional, Lima.

29 E-mail interview with Pedro Pablo Kuczynski, son of Máxime Kuczynski, 9 June 1999.

30 Maletta, Héctor and Bardales, Alejandro, Perú: Las provincias en cifras, 1876–1981, Vol. 1 (Lima: Universidad del Pacifico/Amidep, 1984), p. 41.Google Scholar

31 Carvallo, Constantino, Memoria del Ministro de Salud Pública y Asistencia Social, Julio 1941-Julio 1945 (Lima: Imp. Torres Aguirre, 1945), p. x.Google Scholar

32 F. F. Hixson to J. D. Kennedy, Acting Secretary, Peruvian Corporation Limited, 6 December 1939. Peruvian Corporation Papers.

33 F. F. Hixson to V. A. Gascoyne-Cecil, Secretary, Peruvian Corporation Limited, 20 April 1939. Peruvian Corporation Papers.

34 Santos, Fernando and Barclay, Federica, Ordenes y Desordenes en la Selva Central: Historia y Economía de un Espacio Regional (Lima: Instituto de Estudios Peruanos, 1995), p. 78.CrossRefGoogle Scholar

35 F. F. Hixson to J. D. Kennedy, Acting Secretary, Peruvian Corporation, London. 23 January 1940. Peruvian Corporation Papers.

36 This study gave rise to several articles published in 1939 in La Reforma Médica, and later collected in a book titled La Colonia del Perené y sus Problemas Médico-Sociales (Lima: La Reforma Médica, 1939), which was divided into three parts, each of which was titled “Memoir.”

37 Kuczynski-Godard, Maxime, “Observaciones Higiénicas en la Perené Colony,” La Reforma Médica (April 15, 1939), p. 352.Google Scholar

38 See Cueto, Marcos, “Sanitation from Above: Yellow Fever and Foreign Intervention in Peru, 1919–1922,” Hispanic American Historical Review 72 (1992), pp. 1–22.Google Scholar

39 The rationale of vertical programs is explained in Soper, Fred. L., “Nation-wide malaria eradication projects in the Americas,” Journal of the National Malaria Society 10 (1951), pp. 183–194;Google ScholarPubMed idem, “Eradication versus control in Communicable Disease Prevention”; and idem, “The Rehabilitation of the Eradication Concept in Prevention of Communicable Disease,” in Soper, Fred L., Building the Health Bridge (Bloomington: Indiana University Press, 1970), pp. 330–336, 337–354.Google Scholar

40 Kuczynski-Godard, Maxime, “La Colonia del Perené y sus problemas médico sociales,” La Reforma Médica (June 15, 1939), p. 502.Google Scholar

41 F. F. Hixson to J. D. Kennedy, Acting Secretary, Peruvian Corporation, London. 23 January 1940. Peruvian Corporation Papers.

42 Paz Soldán, Carlos Enrique and Kuczynski-Godard, Maxime, La Selva Peruana, sus Pobladores y su Colonización en Seguridad Sanitaria (Lima: La Reforma Médica, 1939).Google Scholar

43 “Inspección médico sanitaria en la selva peruana, Comisión, Febrero 27, 1940,” in Prontuario de Legislación Sanitaria del Perú, Recopilación de Leyes, Decretos y Demás Disposiciones Relativas a Cuestiones Sanitarias, Vol. 4 (1935–1947), Parte, Primera (Lima: Imp. D. Miranda, 1947), p. 360 Google Scholar (henceforward Prontuario). Diseases of Loreto are described (with no figures) in Lorente, Sebastián and Cordova, Raúl Flores, Estudios sobre Geografía Médica y Patología del Perú (Lima: Imprenta Americana, 1925).Google Scholar On the relationship between some of these ailments and malnutrition, Kuczynski published El Hambre de Proteínas, la Anquilostomiasis y la Opilación (Lima: La Reforma Médica, 1940).

44 “Supervisión Sanitaria del Nor Oriente, Abril 16, 1941,” in Prontuario, pp. 496–498.

45 Klaren, Peter, Perú: Society and Nationhood in the Andes (Oxford: Oxford Univ. Press, 2000), p. 281.Google Scholar See also Portocarrero, Felipe, El Imperio Prado, 1890–1970 (Lima: Universidad del Pacífico, 1995)Google Scholar and Haworth, Nigel, “Perú,” in Latin America Between the Second World War and the Cold War, 1944–1948, Bethell, Leslie and Roxborough, Ian, ed. (Cambridge. Cambridge University Press, 1992), pp. 170–189.Google Scholar

46 List of ministers in the webpage of the Peruvian Ministerio de Salud [http://www. minsa.gob.pe/ministerio/ministros/Listado.htm. last accessed March 18, 2004].

47 Carvallo, Memoria del Ministro, p. x.

48 Cuadro comparativo de las partidas votadas en el pliego del presupuesto del Ministerio de Salud Pública y Asistencia Social para la Dirección de Salubridad.” Carvallo, , Memoria del Ministro, p. 29.Google Scholar

49 The number of inhabitants is from the 1940 census (see citation 10). See also Barclay, Frederica, Santos, Fernando, Rodriguez, Martha and Valcarcel, Marcel, Amazonia: el extravío de una ilusión (Lima: PUCP, 1991), p. 153.Google Scholar Kuczynski, Maxime, Los escolares de Iquitos (Lima: Imp. Lux, 1942).Google Scholar

50 Kuczynski, Maxime, “Civilización del Indio Selvícola,” América Indígena (México) 3:4 (1943), pp. 313–321.Google Scholar

51 Soldán's, Paz statement appears in: “Información radiada sobre el avance sanitario hacia la selva,” La Reforma Médica (March 15, 1940), p. 317.Google Scholar

52 “Párrafos del Mensaje leído por el Sr. Presidente de la República Dr. Manuel Prado en el Congreso Nacional, 28 de Julio de 1940,” in Ministerio de Salud Pública, Trabajo y Previsión Social, Boletín de la Dirección General de Salubridad (Lima: Imp. Americana, 1941), pp. 3–10, 6.

53 Prado, Manuel “La Salubridad Pública en el Perú,” Boletín de la Oficina Sanitaria Panamericana (Washington D.C.) 21, 1 (Enero 1942), pp. 13–19, 18.Google Scholar

54 Rebagliati, Raúl, “La Situación Epidemológica de Perú en 1939,” Boletín de la Dirección General de Salubridad (Lima: Imp. Americana, 1941), pp. 241–265, 262.Google Scholar

55 In “El Gobierno consagra la cruzada colonizadora en seguridad sanitaria de la selva Amazónica,” La Reforma Médica (March 15, 1940), p. 202.

56 Ruiz, Alfredo Estrella “El Problema de la Lepra en el Oriente Peruano,” La Reforma Médica ([no month] 1935), pp. 565–568.Google Scholar

57 “Resolución Suprema Marzo 17, 1905.” Prontuario, Tomo I, p. 66.

58 Romero, Juan Cascajo, Pleito de la curación de la lepra en el Hospital de San Lázaro de Lima (Sevilla: Escuela de Estudios Hispanoamericanos, 1948).Google Scholar

59 Pesce, Hugo, “La epidemiología de la Lepra en el Perú,” Anales de la Facultad de Medicina de la Universidad Mayor San Marcos (Lima) 44: 1 (Enero-Marzo 1961), pp. 1–104.Google Scholar

60 Only in the 1950s the practíce of isolating the sick began to disappear throughout the world. It was only in the past two decades that Hansen's disease could be effectively cured with a multiple drug therapy. Another major change was reconstructive surgery. Trauman, John R., “The History of Leprosy,” in Leprosy, Hastings, Robert C. and Opromolla, Diltor V.A., eds. (Edinburgh: Churchill Livingstone, 1994), pp. 11–25.Google Scholar

61 Worboys, Michael, “Tropical Diseases,” in Companion Encyclopedia of the History of Medicine, Vol. 1, Bynum, W.F. and Porter, Roy, eds. (London: Routledge, 1993), pp. 512–537, 531.Google Scholar

62 “Epidemiología y Control de la Lepra: Informe de la subcomisión de Epidemiología y. Control del Congreso Internacional de la Lepra, elaborado en el Cairo en Marzo de 1938,” Boletín de la Oficina Sanitaria Panamericana 17:9 (Agosto 1938), pp. 695–701.

63 Ruiz, Estrella, “El Problema,” p. 568.Google Scholar

64 Pesce, Hugo, La Epidemiología de la Lepra en el Perú (Lima: Universidad Nacional Mayor de San Marcos, 1961), p. 41;Google Scholar idem, “La epidemiología de la Lepra en el Perú,” Anales de la Facultad de Medicina de la Universidad Mayor San Marcos. [Lima] 44:1 (Enero-Marzo 1961 ), pp. 1–104; and “El Estado, la Salud Pública y la Asistencia Social,” in Marie, Sainte, Perú en Cifras, 1944–1945, p. 744.Google Scholar

65 Other studies by Kuczynski on this region were: San Pablo, actualidad y porvenir, un informe sobre la reorganización de la Colonia con apuntes sobre la sociología médica de la lepra en el Oriente Amazónico (Lima: Imp. Lux, 1942); La Vida en la Amazonía peruana, observaciones de un Médico (Lima: Imp. Lux, 1944).

66 This appears in his brief introduction to Vida de una Leprosa (Lima: La Reforma Médica, 1947), p. 1. This pamphlet will be analyzed in the following section.

67 An example of his attempt to understand the indigenous conceptions of health and disease is his article “El pensamiento-mítico del campesino peruano, ensayo de interpretación” Anales de la Sociedad Peruana de Historia de la Medicina (Lima) 9 (1947), pp. 4–44.

68 The pamphlet is in the National Library of Lima: Vida de una Leprosa [hereafter Vida]. The publication has a subtitle “Narraciones médico-sociales extraordinarias.” Another patient's narrative outside Peru is Burguess, Perry, Who Walk Alone (New York: Holt, 1940).Google Scholar On Catagua or Catahua, see Silva, Hermann and Ruíz, Juan García, La Medicina Tradicional en Loreto (Iquitos: Instituto Peruano de Seguridad Social, 1997), p. 76.Google Scholar According to a study the herb cured Hansen's disease and is still used for asthma and snake bites (among other illnesses); see Egg, Antonio Brack, “Plantas nativas utilizadas en el Perú en relación con la salud humana,” in Salud y Población Indígena de la Amazonía, Estrella, Eduardo and Crespo, Antonio, eds., Vol. 2 (Quito: Tratado de Cooperación Amazónica, 1993), pp. 61–176;Google Scholar see also pp. 107–108, 161.

69 A remarkable exception is Porter, Roy and Porter, Dorothy, Patient's progress: doctors and doctoring in eighteenth century England (Oxford: Blackwell, 1989).Google Scholar Latin American studies that include the perspective of the patients include: Filho, Claudio Bettolìi, “Antropologia da doença e do doente: percepções e estratégias de vida dos tuberculosos,” Historia, Ciências, Saúde: Manguinhos 6 (2000), pp. 493–522;CrossRefGoogle Scholar idem, Historia social da tuberculose e do tuberculoso: 1900–1950 (Rio de Janeiro, Fiocruz, 2001); Obregon, Diana, “The State, Physicians and Leprosy in Modem Colombia,” in Armus, Diego, ed., Disease in the history of modem Latin America. From Malaria to AIDS (Durham: Duke University Press, 2003), pp. 130–157;CrossRefGoogle Scholar Armus, Diego, “!Queremos a vacina Pueyo!" Incertezas biomédicas, enfermos que protestam e a imprensa. Argentina, 1920–1940,” in Hochman, Gilberto and Armus, Diego, eds., Cuidar, Controlar, Curar: Estudos de Historia da Saúde e da Doença na America Latina e Caribe (Rio de Janeiro, Fiocruz, forthcoming).Google Scholar

70 Vida, p. 4.

71 Vida, p. 9.

72 Vida, p. 10.

73 Vida, p. 16.

74 Silva, Federico Bresani, “El Síndrome Neural Leproso: Ensayo de sistematización,” reprint of the Revista Peruana de Salud Publica 6 (1956), pp. 1–90,Google Scholar 88. Library of the Universidad Cayetano Heredia (Lima).

75 For its use in the Amazon, see Mora, Carlos, “Una revisión del concepto de Cholo en la Amazonía Peruana,” Amazonia Peruana 25 (Octubre 1995), pp. 145–148.CrossRefGoogle Scholar

76 Silva, Bresani “El Síndrome Neural,” p. 88.Google Scholar

77 Ullman, James Ramsey, The Other Side of the Mountain: An Escape to the Amazon (New York: Carrick and Evans, 1938), p. 237.Google Scholar This book is available at the Biblioteca Nacional, Lima.

78 Vida, p. 14.

79 Vida, p. 10–11.

80 Kuczynski a Sigerist, Enero 16, 1947 and Abril 16, 1947. A collection of letters between Kuczynski and Henry Sigerist are kept in the Sigerist Papers Collection, Alan Manson Chesney Archives, The Johns Hopkins Medical Institution, Baltimore, Maryland, USA (hereafter cited as Sigerist Papers).

81 Vida, p. 15.

82 Vida, p. 12

83 “Supervisión Sanitaria del Nor Oriente, Abril 16, 1941,” and “Supervisión de Sanidad y Asistencia del Nor Oriente, Febrero 28, 1942,” Prontuario, pp. 496–498 and 623–624.

84 “Servicio Cooperativo InterAmericano de Salud Pública Julio 14, 1942,” Prontuario, pp. 60–661.

85 “Salud Pública y Asistencia Social,” in Mensaje Presentado al Congreso por el Señor Doctor Don José Luis Bustamante y Rivero, Presidente Constitucional de la República, Lima-Perú, 1946 (Lima: Tip. Peruana, 1946), p. 186.

86 Kuczynski to Henry Sigerist; 1st October 1944. Sigerist Papers.

87 “Servicio Nacional Antileproso, Enero 17, 1944,” Prontuario, pp. 845–847.

88 Maletta, , Perú: las provincias, pp. 41–43.Google Scholar

89 Kuczynski, Maxime, La Protección del Hombre en el Estado del Porvenir, sentido y finalidad de los servicios médico-sociales con referencia especial a las condiciones del Oriente Peruano (Lima: Imp. Lux, no date; according to Catalogue of National Library of Perú, 194?), p. 19.Google Scholar

90 Ministerio de Salud Pública y Asistencia Social, Presupuestos Administrativos para el año 1943 (Lima: Imp. Americana, 1943), pp. 10–11 ; Idem, Presupuestos Administrativos, 1945 (Lima: Imp. Americana, 1945), p. 121.

91 Kuczynski-Godard, Maxime H., La Pampa de llave; Estudios Médico-Sociales en las Minas de Puno, con anotaciones sobre las migraciones indígenas (Lima: Scheuch, 1945);Google Scholar A Propósito del saneamiento de los valles yungas del Cuzco (la Convención, Lares y Ocobamba) (Lima: Imp. La Tinta, 1946); 1. Estudio Familiar demográfico-ecológico, en estancias indias de la altiplanicie del Titicaca (Ichupampa) 2. La Condición social del indio y su insalubridad, miradas sociográficas del Cuzco 3. El Instituto Médico Higiénico Social del Sur, un proyecto organizador (Lima: Ministerio de Salud Pública y Asistencia Social, 1945).

92 Kuczynski-Godard, Maxime H. and Paz Soldán, Carlos Enrique, Disección del Indigenismo Peruano, un examen sociológico y medico social (Lima: Instituto de Medicina Social, 1948), pp. 141, 146.Google Scholar

93 Ibid., p. 26.

94 Kuczynski to Isaiah Bowman, 29th June 1945, Sigerist Papers. A copy of the letter was sent by Bowman to Sigerist. 20 January 1947.

95 List of ministers in the webpage of the Peruvian Ministerio de Salud (http://www.minsa. gob.pe/ministerio/ministros/Listado:htm. last accessed March 18, 2004).

96 Kuczynski to Sigerist, 8 January 1944 and Kuczynski to Sigerist, 1 October 1944, Sigerist Papers.

97 E-mail interview with Pedro Pablo Kuczynski, 9 June 1999.

98 A recent study of changes in the region is Santos, Fernando and Barclay, Frederica, La Frontera Domesticada: historia económica y social de Loreto, 1850–2000 (Lima: Pontificia Universidad Católica, 2002).Google Scholar